Investigating altered consciousness (summary)

Last revised by Rohit Sharma on 25 Feb 2024
This is a basic article for medical students and other non-radiologists

Altered consciousness or confusion is a common reason for admission to hospital, and involvement of radiology 1,2.

Although the most common reason for acute confusion is intoxication which will improve - when altered neurology is present or the changes persists, more serious reasons need investigated.

Reference article

This is a summary article; we do not have a more in-depth reference article.

  • questions

    • any systemic cause for confusion?

      • e.g. sepsis, hypoglycemia and drug interactions

    • any direct causes?

      • e.g. trauma, pressure effects, infarction or infection

    • are there any focal neurological signs?

    • is there any relevant medication history?

      • e.g. anticoagulants, alcohol, narcotics?

  • investigations

    • CT head is the first line investigation, especially in the acute setting

      • 10% of patients will have a cause found 1

    • MRI can be performed, but usually only after CT

  • making the request

    • what is the likely underlying cause of confusion?

    • what is the urgency of the study?

  • common pathology

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